Zika virus (ZIKV) infection related with immune thrombocytopenic purpura (ITP) exacerbation and antinuclear antibody positivity

Abstract

A 30-year-old Colombian woman with past history of immune thrombocytopenia (ITP) presented to the emergency room with two days of global headache, arthralgia, myalgia, and low level fever and generalized erythematous rash. Platelets dropped to 9 × 109/L (fourth day of symptoms) without hemorrhagic manifestations but recovered to 30 × 109/L in 24 hours (fifth day). Dengue virus infection, as well as other viral infections, was ruled out. Zika virus (ZIKV) was evaluated in serum and urine samples by real-time reverse-transcriptase polymerase chain reaction (genomic regions within E protein and NS2b protein). Urine sample was positive and serum sample negative for ZIKV, confirming a recent ZIKV infection with urinary tract virus excretion at 7th day after disease onset. To our knowledge this is the first description of a case of severe immune thrombocytopenia exacerbation and antinuclear antibody positivity induced by ZIKV infection.